1 a good practice guide SUPPORTING PUPILS WITH MEDICAL NEEDS DEPARTMENT OF HEALTH
2 contents Paragraphs Introduction Purpose of Guidance 1-5 Pupils with Medical Needs 6-8 Support for Pupils with Medical Needs 9-11 Chapter 1 - Medication in Schools: Who is Responsible? Introduction 12 Parents and Guardians The Employer The Governing Body 20 The Headteacher Teachers and Other School Staff School Staff Giving Medication 28 The Local Education Authority Health Authorities The School Health Service The School Nurse/Doctor The General Practitioner 37 Other Health Professionals Chapter 2 - Developing Policies and Procedures for Supporting Pupils with Medical Needs Introducing a Policy Short Term Medical Needs Non-Prescription Medication Long Term Medical Needs Administering Medication Self-Management 53 Refusing Medication 54 Record Keeping School Trips Sporting Activities School Transport 63 Chapter 3 - Dealing with Medicines Safely Safety Management 64 Storing Medication Access to Medication 70 Disposal of Medicines 71 Hygiene/Infection Control 72 Emergency Procedures 73-74
3 Chapter 4 - Drawing up a Health Care Plan for a Pupil with Medical Needs Purpose of a Health Care Plan Co-ordinating Information 78 Information for Staff and Others 79 Staff Training 80 Confidentiality 81 Intimate or Invasive Treatment 82 Chapter 5 - Asthma, Epilepsy, Diabetes and Anaphylaxis: Common Concerns 83 What is Asthma? Medication and Control What is Epilepsy? Medication and Control What is Diabetes? 107 Medication and Control Hypoglycaemic Reaction What is Anaphylaxis? 115 Medication and Control Allergic Reactions Annex A - Useful Contacts and Helplines Voluntary Support Groups Teacher Unions Others
4 introduction Purpose of Guidance 001 This guidance has been written to help schools draw up policies on managing medication in schools, and to put in place effective management systems to support individual pupils with medical needs. A positive response by the school to a pupil s medical needs will not only benefit the pupil directly, but can also positively influence the attitude of the whole class. 002 This guidance should be read in conjunction with DfEE/DH circular - Supporting Pupils with Medical Needs in School which sets out the legal framework for the health and safety of pupils and staff. with some support from the school, can take part in most normal school activities. However, school staff may need to take extra care in supervising some activities to make sure that these pupils, and others, are not put at risk. 008 An individual health care plan can help schools to identify the necessary safety measures to support pupils with medical needs and ensure that they and others are not put at risk. Detailed procedures on how to draw up a health care plan are included in this guidance. Support for Pupils with Medical Needs 003 It is for authorities, schools and governing bodies to formulate their own policies in the light of their statutory responsibilities and their own assessment of local needs and resources, but it is hoped that when doing so they will find this guidance helpful. 004 Proforma are provided, as part of this pack, which can be photocopied or adapted for use by schools. 005 This guidance is not a definitive interpretation of the law: interpreting the law is a matter for the Courts alone. Pupils with Medical Needs 006 Most pupils will at some time have a medical condition that may affect their participation in school activities. For many this will be short-term; perhaps finishing a course of medication. 007 Other pupils have medical conditions that, if not properly managed, could limit their access to education. Such pupils are regarded as having medical needs. Most children with medical needs are able to attend school regularly and, 009 Parents or guardians have prime responsibility for their child s health and should provide schools with information about their child s medical condition. Parents, and the pupil if he/she is mature enough, should give details in conjunction with their child s GP or paediatrician, as appropriate. The school doctor or nurse and specialist voluntary bodies may also be able to provide additional background information for school staff. 010 The School Health Service can provide advice on health issues to pupils, parents, teachers, education officers and local authorities. Health Authorities, LEAs and governing bodies should work together to ensure pupils with medical needs and school staff have effective support in schools. 011 There is no legal duty which requires school staff to administer medication; this is a voluntary role. Staff who provide support for pupils with medical needs, or who volunteer to administer medication, need support from the head and parents, access to information and training, and reassurance about their legal liability. 1
5 1 Medication in Schools: Who is Responsible? Introduction The Employer 012 It is important that responsibility for pupils safety is clearly defined and that each person involved with pupils with medical needs is aware of what is expected of them. Close cooperation between schools, parents, health professionals and other agencies will help provide a suitably supportive environment for pupils with medical needs. 016 The employer, generally the school governing body or the LEA, is responsible, under the Health and Safety at Work etc Act 1974, for making sure that a school has a health and safety policy. This should include procedures for supporting pupils with medical needs, including managing medication. Parents and Guardians 013 Parents, as defined in the Education Act 1944, are a child s main carers. They are responsible for making sure that their child is well enough to attend school. 014 Parents should provide the head with sufficient information about their child s medical condition and treatment or special care needed at school. They should, jointly with the head, reach agreement on the school s role in helping with their child s medical needs. Parents cultural and religious views should always be respected. Ideally, the head should seek parents agreement before passing on information about their child s health to other school staff. Sharing information is important if staff and parents are to ensure the best care for a pupil. 017 The employer must also make sure that their insurance arrangements provide full cover for staff acting within the scope of their employment. Some LEAs provide explicit reassurance to staff that those in county and controlled schools who volunteer to assist with any form of medical procedure are acting within the scope of their employment and are indemnified. 018 In the event of legal action over an allegation of negligence, the employer rather than the employee is likely to be held responsible. It is the employer s responsibility to make sure that correct procedures are followed. Keeping accurate records in the school is helpful in such cases. Teachers and other staff are expected to use their best endeavours at all times, particularly in emergencies. In general, the consequences of taking no action are likely to be more serious than those of trying to assist in an emergency. 015 Some parents may have difficulty understanding or supporting their child s medical condition themselves. The School Health Service can often provide additional assistance in these circumstances. 019 The employer is also responsible for making sure that willing staff have appropriate training to support pupils with medical needs. This should be arranged in conjunction with the Health Authority or other health professionals. Health Authorities have the discretion to make resources available for any necessary training. In many instances they will be able to provide the training themselves. The employer should be satisfied that any training has given staff sufficient 2
6 understanding, confidence and expertise. A health care professional should confirm proficiency in medical procedures. The Governing Body 020 Individual schools develop their own policies to cover the needs of their own school. The governing body has general responsibility for all of the school s policies even when it is not the employer. The governing body will generally want to take account of the views of the head, staff and parents in developing a policy on assisting pupils with medical needs. In LEA schools the governing body should follow the health and safety policies and procedures produced by the LEA as the employer. The Headteacher 021 The head is responsible for implementing the governing body s policy in practice and for developing detailed procedures. When teachers volunteer to give pupils help with their medical needs, the head should agree to their doing this, and must ensure that teachers receive proper support and training where necessary. Day to day decisions about administering medication will normally fall to the headteacher. 022 The head should make sure that all parents are aware of the school s policy and procedures for dealing with medical needs. The school s policy should make it clear that parents should keep children at home when they are acutely unwell. The policy should also cover the school s approach to taking medication at school. 023 The local Consultant in Communicable Disease Control (CCDC) can advise on the circumstances in which pupils with infectious diseases should not be in school, and the action to be taken following an outbreak of an infectious disease. 024 For a child with medical needs, the head will need to agree with the parents exactly what support the school can provide. Where there is concern about whether the school can meet a pupil s needs, or where the parents expectations appear unreasonable, the head can seek advice from the school nurse or doctor, the child s GP or other medical advisers and, if appropriate, the LEA. Complex medical assistance is likely to mean that the staff who volunteer will need special training. 025 If staff follow the school s documented procedures, they will normally be fully covered by their employer s public liability insurance should a parent make a complaint. The head should ask the employer to provide written confirmation of the insurance cover for staff who provide specific medical support. Teachers and Other School Staff 026 Some school staff are naturally concerned about their ability to support a pupil with a medical condition, particularly if it is potentially life threatening. Teachers who have pupils with medical needs in their class should understand the nature of the condition, and when and where the pupil may need extra attention. The pupil s parents and health professionals should provide this information. Staff should be aware of the likelihood of an emergency arising and what action to take if one occurs. Back up cover should be arranged for when the member of staff responsible is absent or unavailable. At different 3
7 times of the school day other staff may be responsible for pupils (e.g. playground assistants). It is important that they are also provided with training and advice. Form 6 provides an example of confirmation that any necessary training has been completed. 027 Many voluntary organisations specialising in particular medical conditions provide advice or produce school packs advising teachers on how to support pupils. Annex A lists contact names and addresses. also arrange training for staff in conjunction with health professionals. Health Authorities 031 Health Authorities (HAs) have a statutory duty to purchase services to meet local needs. National Health Service (NHS) Trusts provide these services. HAs, LEAs and school governing bodies should work in cooperation to determine need and plan and coordinate effective local provision within the resources available. School Staff Giving Medication 028 Teachers conditions of employment do not include giving medication or supervising a pupil taking it, although staff may volunteer to do this and many are happy to do so. Any member of staff who agrees to accept responsibility for administering prescribed medication to a pupil should have proper training and guidance. He or she should also be aware of possible side effects of the medication and what to do if they occur. The type of training necessary will depend on the individual case. The Local Education Authority 029 In county and controlled schools the LEA, as the employer, is responsible for all health and safety matters. 030 The LEA can provide a general policy framework of good practice to guide county and controlled schools in drawing up their own policies on supporting pupils with medical needs. Many LEAs find it useful to work closely with their Health Authority when drawing up a policy. The LEA may 032 Health Authorities normally designate a medical officer with specific responsibility for children with special educational needs (SEN). Some of these children may have medical needs. NHS trusts, usually through the School Health Service, may provide advice and training for school staff in providing for a pupil s medical needs. The School Health Service 033 The School Health Service is usually a part of an NHS Trust. The nature and scope of the service to schools varies between Health Authorities. It can provide advice on health issues to children, parents, teachers, education welfare officers and local authorities. The main contact for schools is likely to be the school nurse employed by the School Health Service. 034 The School Health Service may also provide guidance on medical conditions and, in some cases, specialist support for a child with medical needs. 4
8 The School Nurse/Doctor 035 Most schools will have contact with the health service through a school nurse or doctor. 036 The school nurse or doctor may help schools draw up individual health care plans for pupils with medical needs, and may be able to supplement information already provided by parents and the child s GP. The nurse or doctor may also be able to advise on training for school staff willing to administer medication, or take responsibility for other aspects of support. The school nurse or doctor may attend school open days or parents evenings to give advice to parents and staff. The General Practitioner (GP) 037 GPs are part of primary health care teams. Most parents will register their child with a GP. A GP has a duty of confidentiality to patients. Any exchange of information between GPs and schools about a child s medical condition should be with the consent of the child (if he/she has the capacity) or otherwise that of the parent or guardian. In some cases parents may agree for GPs to advise teachers directly about a child s condition, in others GPs may do so by liaising with the School Health Service. 039 Most NHS Trusts with School Health Services have specialist trained pharmacists, often referred to as Community Services Pharmacists. Community Pharmacists provide pharmaceutical advice to School Health Services normally through Community Health Trusts. Some work closely with local authority education departments and give advice on the management of medicines within schools. This can involve helping to prepare policies related to medicines in schools and training school staff. In particular, they can advise on the storage, handling and disposal of medicines. 040 Some pupils with medical needs will receive dedicated support from a specialist nurse or community paediatric nurse. These nurses often work as part of an NHS Acute or Community Trust and work closely with the primary health care team. They can provide advice on the medical needs of an individual pupil, particularly when a medical condition has just been diagnosed and the pupil is adjusting to new routines. Other Health Professionals 038 Other health professionals may also be involved in the care of pupils with medical needs in schools. The Community Paediatrician is a specialist doctor with an interest in disability, chronic illness and the impact of ill health on children. He/she may give advice to the school on individual pupils or on health problems generally. 5
9 2 Developing Policies and Procedures for Supporting Pupils with Medical Needs Introducing a Policy 041 A clear policy understood and accepted by staff, parents and pupils provides a sound basis for ensuring that children with medical needs receive proper care and support at school. Policies should, as far as possible, enable regular school attendance. Formal systems and procedures, drawn up in partnership with parents and staff should back up the policy. 042 A school policy needs to be clear to all parents and pupils. The school could include this in its prospectus, or in other information for parents. A policy might cover: whether the head accepts responsibility, in principle, for school staff giving or supervising children taking prescribed medication during the school day the circumstances in which children may take non-prescription medication e.g. pain killers (analgesics) 043 Parents should be encouraged to provide the school with full information about their child s medical needs. Staff noticing a deterioration in a pupil s health over time should inform the head who should let the parents know. Short Term Medical Needs 044 Many pupils will need to take medication (or be given it) at school at some time in their school life. Mostly this will be for a short period only; to finish a course of antibiotics or apply a lotion. To allow pupils to do this will minimise the time they need to be off school. Medication should only be taken to school when absolutely essential. 045 It is helpful if, where possible, medication can be prescribed in dose frequencies which enable it to be taken outside school hours. Parents should be encouraged to ask the prescribing doctor or dentist about this. the school s policy on assisting pupils with long term or complex medical needs the need for prior written agreement from parents or guardians for any medication, prescribed or non-prescription, to be given to a child policy on pupils carrying and taking their medication themselves staff training in dealing with medical needs Non-Prescription Medication 046 Pupils sometimes ask for pain killers (analgesics) at school, including aspirin and paracetamol. School staff should generally not give nonprescribed medication to pupils. They may not know whether the pupil has taken a previous dose, or whether the medication may react with other medication being taken. A child under 12 should never be given aspirin, unless prescribed by a doctor. record keeping storage and access to medication the school s emergency procedures 047 If a pupil suffers regularly from acute pain, such as migraine, the parents should authorise and supply appropriate pain killers for their child s use, with written instructions about when the child should take the medication. A member of staff 6
10 should supervise the pupil taking the medication and notify the parents, in writing, on the day painkillers are taken. Long Term Medical Needs Administering Medication 050 No pupil under 16 should be given medication without his or her parent s written consent. Any member of staff giving medicine to a pupil should check: 048 It is important for the school to have sufficient information about the medical condition of any pupil with long term medical needs. If a pupil s medical needs are inadequately supported this can have a significant impact on a pupil s academic attainments and/or lead to emotional and behavioural problems. The school therefore needs to know about any medical needs before a child starts school, or when a pupil develops a condition. For pupils who attend hospital appointments on a regular basis, special arrangements may also be necessary. It is often helpful for a school to draw up a written health care plan for such pupils, involving the parents and relevant health professionals. This can include: details of a pupil s condition the pupil s name written instructions provided by parents or doctor prescribed dose expiry date 051 If in doubt about any of the procedures the member of staff should check with the parents or a health professional before taking further action. 052 It is good practice for staff to complete and sign record cards each time they give medication to a pupil. Form 4 can be used for this purpose. In some circumstances, it is good practice to have the dosage and administration witnessed by a second adult. special requirements e.g. dietary needs, preactivity precautions Self Management medication and any side effects what to do, and who to contact in an emergency the role the school can play 049 Form 1 provides an example of a health care plan, which schools may wish to use or adapt. 053 It is good practice to allow pupils who can be trusted to do so to manage their own medication from a relatively early age and schools should encourage this. If pupils can take their medicine themselves, staff may only need to supervise this. The school policy should say whether pupils can carry and administer their own medication, bearing in mind also the safety of other pupils. A suggested parental consent form is provided in Form 5. 7
11 Refusing Medication 054 If pupils refuse to take medication, school staff should not force them to do so. The school should inform the child s parents as a matter of urgency. If necessary, the school should call the emergency services. 058 Although there is no legal requirement for schools to keep records of medicines given to pupils, and the staff involved, it is good practice to do so. Records offer protection to staff and proof that they have followed agreed procedures. Some schools keep a log book for this. Form 4 provides a model record sheet. Record Keeping 055 Parents are responsible for supplying information about medicines that their child needs to take at school, and for letting the school know of any changes to the prescription or the support needed. The parent or doctor should provide written details including: name of medication dose method of administration time and frequency of administration other treatment any side effects 056 It can be helpful to give parents a form similar to Form 2 to record the details of medication in a standard format. The child s GP may be willing to provide confirmation of the medication. Other circumstances when a school may need to make special arrangements for pupils with medical needs School Trips 059 It is good practice for schools to encourage pupils with medical needs to participate in schools trips, wherever safety permits. 060 Sometimes the school may need to take additional safety measures for outside visits. Arrangements for taking any necessary medication will also need to be taken into consideration. Staff supervising excursions should always be aware of any medical needs, and relevant emergency procedures. Sometimes an additional supervisor or parent might accompany a particular pupil. If staff are concerned about whether they can provide for a pupil s safety, or the safety of other pupils on a trip, they should seek medical advice from the School Health Service or the child s GP. For further information on school trips see DFE Circular 22/94 Safety in Outdoor Activity Centres: Guidance. 057 Form 3 provides a sample confirmation note which schools may wish to give to parents to let them know that a member of staff will assist with medication. Sporting Activities 061 Most pupils with medical conditions can participate in extra-curricular sport or in the PE curriculum which is sufficiently flexible for all pupils 8
12 to follow in ways appropriate to their own abilities. For many, physical activity can benefit their overall social, mental and physical health and well-being. Any restrictions on a pupil s ability to participate in PE should be included in their individual health care plan. 062 Some pupils may need to take precautionary measures before or during exercise, and/or need to be allowed immediate access to their medication if necessary. Teachers supervising sporting activities should be aware of relevant medical conditions and emergency procedures. School Transport 063 LEAs arrange home to school transport where legally required to do so. They must make sure that pupils are safe during the journey. Most pupils with medical needs do not require supervision on school transport, but LEAs should provide appropriately trained supervisors if they consider them necessary. 9
13 3 Dealing with Medicines Safely Safety Management 064 Some medicines may be harmful to anyone for whom they are not prescribed. Where a school agrees to administer this type of medicine the employer has a duty to ensure that the risks to the health of others are properly controlled. This duty derives from the Control of Substances Hazardous to Health Regulations 1994 (COSHH). Storing Medication 065 Schools should not store large volumes of medication. The head should ask the parent or pupil to bring in the required dose each day. However, this is not always possible. 066 When the school stores medicines staff should ensure that the supplied container is labelled with the name of the pupil, the name and dose of the drug and the frequency of administration. Where a pupil needs two or more prescribed medicines, each should be in a separate container. Non health care staff should never transfer medicines from their original containers. The head is responsible for making sure that medicines are stored safely. Pupils should know where their own medication is stored and who holds the key. A few medicines, such as asthma inhalers, must be readily available to pupils and must not be locked away. Many schools allow pupils to carry their own inhalers. Other medicines should generally be kept in a secure place not accessible to pupils. 067 If the school locks away medication that a pupil might need in an emergency, all staff should know where to obtain keys to the medicine cabinet. 068 Some medicines need to be refrigerated. Medicines can be kept in a refrigerator containing food but should be in an airtight container and clearly labelled. The school should restrict access to a refrigerator holding medicines. 069 Local and community services pharmacists may give advice to schools about storing medicines. Access to Medication 070 Pupils must have access to their medicine when required. The school may want to make special access arrangements for emergency medication that it keeps. However, it is also important to make sure that medicines are only accessible to those for whom they are prescribed. This should be considered as part of the school s policy about pupils carrying their own medication. Disposal of Medicines 071 School staff should not dispose of medicines. Parents should collect medicines held at school at the end of each term. Parents are responsible for disposal of date-expired medicines. Hygiene/Infection Control 072 All staff should be familiar with normal precautions for avoiding infection and must follow basic hygiene procedures. Staff should have access to protective disposable gloves and take care when dealing with spillages of blood or other body fluids and disposing of dressings or equipment. Further guidance is available in the DfEE publication HIV and Aids: A Guide for the Education Service. 10
14 Emergency Procedures 073 All staff should know how to call the emergency services. All staff should also know who is responsible for carrying out emergency procedures in the event of need. Guidance on calling an ambulance is provided on Form 8. A pupil taken to hospital by ambulance should be accompanied by a member of staff who should remain until the pupil s parent arrives. 074 Generally staff should not take pupils to hospital in their own car. However, in an emergency it may be the best course of action. The member of staff should be accompanied by another adult and have public liability vehicle insurance. 11
15 4 with Drawing up a Health Care Plan for a Pupil Medical Needs Purpose of a Health Care Plan 075 The main purpose of an individual health care plan for a pupil with medical needs is to identify the level of support that is needed at school. A written agreement with parents clarifies for staff, parents and the pupil the help that the school can provide and receive. Schools should agree with parents how often they should jointly review the health care plan. It is sensible to do this at least once a year. 076 The school should judge each pupil s needs individually as children and young people vary in their ability to cope with poor health or a particular medical condition. However, the school s medication policy must be applied uniformly. The head should not make value judgements about the type of medication prescribed by a registered medical or dental practitioner. 077 Drawing up a health care plan should not be onerous, although each plan will contain different levels of detail according to the needs of the individual pupil. Schools could use or adapt Form 1. Those who may need to contribute to a health care plan are: the headteacher the school health service, the child s GP or other health care professionals (depending on the level of support the child needs) Coordinating Information 078 Coordinating and disseminating information on an individual pupil with medical needs, particularly in secondary schools, can be difficult. The head may give a member of staff specific responsibility for this role. This person can be a first contact for parents and staff, and liaise with external agencies. The Special Educational Needs Coordinator sometimes takes on this role. Information for Staff and Others 079 Staff who may need to deal with an emergency will need to know about a pupil s medical needs. The head must make sure that supply teachers know about any medical needs. When a secondary school arranges work experience, the head should ensure that the placement is suitable for a student with a particular medical condition. Students should be encouraged to share relevant medical information with employers. the parent or guardian Staff Training the child (if sufficiently mature) class teacher (primary schools)/form tutor/head of year (secondary schools) care assistant or support staff (if applicable) school staff who have agreed to administer medication or be trained in emergency procedures 080 A health care plan may reveal the need for some school staff to have further information about a medical condition or specific training in administering a particular type of medication or in dealing with emergencies. School staff should not give medication without appropriate training from health professionals. If school staff volunteer to assist a pupil with medical needs, the employer should arrange appropriate training in 12
16 conjunction with the Health Authority, who will be able to advise on further training needs. Confidentiality 081 The head and school staff should treat medical information confidentially. The head should agree with the pupil (where he/she has the capacity) or otherwise the parent, who else should have access to records and other information about a pupil. If information is withheld from staff they should not generally be held responsible if they act incorrectly in giving medical assistance but otherwise in good faith. Intimate or Invasive Treatment 082 Some school staff are understandably reluctant to volunteer to administer intimate or invasive treatment because of the nature of the treatment, or fears about accusations of abuse. Parents and heads must respect such concerns and should not put any pressure on staff to assist in treatment unless they are entirely willing. Each Health Authority will have a named professional to whom schools can refer for advice. The head or governing body should arrange appropriate training for school staff willing to give medical assistance. If the school can arrange for two adults, one the same gender as the pupil, to be present for the administration of intimate or invasive treatment, this minimises the potential for accusations of abuse. Two adults often ease practical administration of treatment too. Staff should protect the dignity of the pupil as far as possible, even in emergencies. 13
17 5 Asthma, Epilepsy, Diabetes and Anaphylaxis: Common Concerns Introduction Medication and Control 083 The medical conditions in children which most commonly cause concern in schools are asthma, diabetes, epilepsy and severe allergic reaction (anaphylaxis). This guidance provides some basic information about these conditions but it is beyond its scope to provide more detailed medical advice and it is important that the needs of pupils are assessed on an individual basis. Asthma What is Asthma? 084 People with asthma have airways which narrow as a reaction to various triggers. The triggers vary between individuals but common ones include viral infections, cold air, grass pollen, animal fur and house dust mites. Exercise and stress can also precipitate asthma attacks in susceptible people. The narrowing or obstruction of the airways causes difficulty in breathing and can be alleviated with treatment. 085 Asthma attacks are characterised by coughing, wheeziness and difficulty in breathing, especially breathing out. The affected person may be distressed and anxious and, in severe attacks, the pupil s skin and lips may become blue. 086 About one in seven children have asthma diagnosed at some time and about one in twenty children have asthma which requires regular medical supervision. 087 There are several medications used to treat asthma. Some are for long term prevention and are normally used out of school hours and others relieve symptoms when they occur (although these may also prevent symptoms if they are used in anticipation of a trigger, e.g. exercise). 088 Most pupils with asthma will relieve their symptoms with medication using an inhaler. It is good practice to allow children with asthma to take charge of and use their inhaler from an early age, and many do. 089 A small number of children, particularly the younger ones, may use a spacer device with their inhaler with which they may need help. In a few severe cases, children use an electrically powered nebulizer to deliver their asthma medication. 090 Each pupil s needs and the amount of assistance they require will differ. 091 Children with asthma must have immediate access to their reliever inhalers when they need them. Pupils who are able to use their inhalers themselves should usually be allowed to carry them with them. If the child is too young or immature to take personal responsibility for their inhaler, staff should make sure that it is stored in a safe but readily accessible place, and clearly marked with the pupil s name. Inhalers should also be available during physical education and sports activities or school trips. 092 It is helpful if parents provide schools with a spare inhaler for their child s use in case the inhaler is left at home accidentally or runs out. Spare reliever inhalers must be clearly labelled with the pupil s name and stored safely. 14
18 093 The medication of any individual pupil with asthma will not necessarily be the same as the medication of another pupil with the same condition. Although major side effects are extremely uncommon for the most frequently used asthma medications, they do exist and may sometimes be made more severe if the pupil is taking other medication. 094 Pupils should not take medication which has been prescribed for another pupil. If a pupil took a puff of another pupil s inhaler there are unlikely to be serious adverse effects. However, schools should take appropriate disciplinary action if inhalers are misused by the owner or other pupils. 095 Pupils with asthma should be encouraged to participate as fully as possible in all aspects of school life, although special consideration may be needed before undertaking some activities. They must be allowed to take their reliever inhaler with them on all off-site activities. Physical activity will benefit pupils with asthma in the same way as other pupils. They may, however, need to take precautionary measures and use their reliever inhaler before any physical exertion. Pupils with asthma should be encouraged to undertake warm up exercises before rushing into sudden activity especially when the weather is cold. They should not be forced to take part if they feel unwell. 096 The health care plan should identify the severity of a pupil s asthma, individual symptoms and any particular triggers, such as exercise or cold air. 097 If a pupil is having an asthma attack, the person in charge should prompt them to use their reliever inhaler if they are not already doing so. It is also good practice to reassure and comfort them whilst, at the same time, encouraging them to breathe slowly and deeply. The person in charge should not put his/her arm around the pupil, as this may restrict breathing. The pupil should sit rather than lie down. If the medication has had no effect after 5-10 minutes, or if the pupil appears very distressed, is unable to talk and is becoming exhausted, then medical advice must be sought and/or an ambulance called. Epilepsy What is Epilepsy? 098 People with epilepsy have recurrent seizures, the great majority of which can be controlled by medication. Around one in 130 children in the UK has epilepsy and about 80% of them attend mainstream schools. Parents may be reluctant to disclose their child s epilepsy to the school. A positive school policy will encourage them to do so and will ensure that both the pupil and school staff are given adequate support. 099 Not all pupils with epilepsy experience major seizures (commonly called fits). For those who do, the nature, frequency and severity of the seizure will vary greatly between individuals. Some may exhibit unusual behaviour (for example, plucking at clothes, or repetitive movements), experience strange sensations, or become confused instead of, or as well as, experiencing convulsions and/or loss of consciousness. 100 Seizures may be partial (where consciousness is not necessarily lost, but may be affected), or generalised (where consciousness is lost). An example of some types of generalised seizures are:- Tonic Clonic Seizures During the tonic phase of a tonic clonic seizure the muscles become rigid and the person usually 15
19 falls to the ground. Incontinence may occur. The pupil s pallor may change to a dusky blue colour. Breathing may be laboured during the seizure. During the clonic phase of the seizure there will be rhythmic movements of the body which will gradually cease. Some pupils only experience the tonic phase and others only the clonic phase. The pupil may feel confused for several minutes after a seizure. Recovery times can vary - some require a few seconds, where others need to sleep for several hours. Absence Seizures These are short periods of staring, or blanking out and are non-convulsive generalised seizures. They last only a few seconds and are most often seen in children. A pupil having this kind of seizure is momentarily completely unaware of anyone/thing around him/her, but quickly returns to full consciousness without falling or loss of muscle control. These seizures are so brief that the person may not notice that anything has happened. Parents and teachers may think that the pupil is being inattentive or is day dreaming. Partial Seizures Partial seizures are those in which the epileptic activity is limited to a particular area of the brain. Simple Partial Seizures (when consciousness is not impaired) This seizure may be presented in a variety of ways depending on where in the brain the epileptic activity is occurring. and detached from their surroundings. They may exhibit what appears to be strange behaviour, such as plucking at their clothes, smacking their lips or searching for an object. Medication and Control 101 The symptoms of most children with epilepsy are well controlled by modern medication and seizures are unlikely during the school day. The majority of children with epilepsy suffer fits for no known cause, although tiredness and/or stress can sometimes affect a pupil s susceptibility. Flashing or flickering lights, video games and computer graphics, and certain geometric shapes or patterns can be a trigger for seizures in some pupils. Screens and/or different methods of lighting can be used to enable photosensitive pupils to work safely on computers and watch TVs. Parents should be encouraged to tell schools of likely triggers so that action can be taken to minimise exposure to them. 102 Pupils with epilepsy must not be unnecessarily excluded from any school activity. Extra care and supervision may be needed to ensure their safety in some activities such as swimming or working in science laboratories. Off-site activities may need additional planning, particularly overnight stays. Concern about any potential risks should be discussed with pupils and their parents, and if necessary, seeking additional advice from the GP, paediatrician or school nurse/doctor. Complex Partial Seizures (when consciousness is impaired) This is the most common type of partial seizure. During a temporal lobe complex partial seizure the person will experience some alteration in consciousness. They may be dazed, confused 103 Some children with tonic clonic seizures can be vulnerable to consecutive fits which, if left uncontrolled, can result in permanent damage. These children are usually prescribed Diazepam for rectal administration. Teachers may naturally be concerned about agreeing to undertake such 16
20 an intimate procedure and it is important that proper training and guidance is given. For advice on intimate/invasive treatment see Chapter 4. Diazepam causes drowsiness so pupils may need some time to recover after its administration. For information on the administration of rectal Diazepam see Form When drawing up health plans, parents should be encouraged to tell schools about the type and duration of seizures their child has, so that appropriate safety measures can be identified and put in place. to have daily insulin injections, to monitor their blood glucose level and to eat regularly. Medication and Control 108 The diabetes of the majority of school-aged children is controlled by two injections of insulin each day. It is unlikely that these will need to be given during school hours. Most children can do their own injections from a very early age and may simply need supervision if very young, and also a suitable, private place to carry it out. 105 Nothing must be done to stop or alter the course of a seizure once it has begun except when medication is being given by appropriately trained staff. The pupil should not be moved unless he or she is in a dangerous place, although something soft can be placed under his or her head. The pupil s airway must be maintained at all times. The pupil should not be restrained and there should be no attempt to put anything into the mouth. Once the convulsion has stopped, the pupil should be turned on his or her side and put into recovery position. Someone should stay with the pupil until he or she recovers and re-orientates. 106 Call an ambulance if the seizure lasts longer than usual or if one seizure follows another without the person regaining consciousness, or where there is any doubt. Diabetes What is Diabetes? 109 Children with diabetes need to ensure that their blood glucose levels remain stable and may monitor their levels using a testing machine at regular intervals. They may need to do this during the school lunch break or more regularly if their insulin needs adjusting. Most pupils will be able to do this themselves and will simply need a suitable place to do so. 110 Pupils with diabetes must be allowed to eat regularly during the day. This may include eating snacks during class-time or prior to exercise. Schools may need to make special arrangements for pupils with diabetes if the school has staggered lunchtimes. If a meal or snack is missed, or after strenuous activity, the pupil may experience a hypoglycaemia episode (a hypo) during which his or her blood sugar level falls to too low a level. Staff in charge of physical education classes or other physical activity sessions should be aware of the need for pupils with diabetes to have glucose tablets or a sugary drink to hand. 107 Diabetes is a condition where the person s normal hormonal mechanisms do not control their blood sugar levels. About one in 700 school-age children has diabetes. Children with diabetes normally need 17
21 Hypoglycaemic Reaction 111 Staff should be aware that the following symptoms, either individually or combined, may be indicators of a hypo in a pupil with diabetes: hunger sweating drowsiness pallor glazed eyes shaking lack of concentration Anaphylaxis What is Anaphylaxis? 115 Anaphylaxis is an extreme allergic reaction requiring urgent medical treatment. When such severe allergies are diagnosed, the children concerned are made aware from a very early age of what they can and cannot eat and drink and, in the majority of cases, they go through the whole of their school lives without incident. The most common cause is food - in particular nuts, fish, dairy products. Wasp and bee stings can also cause allergic reaction. In its most severe form the condition can be life-threatening, but it can be treated with medication. This may include antihistamine, adrenaline inhaler or adrenaline injection, depending on the severity of the reaction. irritability Medication and Control 112 Each pupil may experience different symptoms and this should be discussed when drawing up the health care plan. 113 If a pupil has a hypo, it is important that a fast acting sugar, such as glucose tablets, a glucose rich gel, a sugary drink or a chocolate bar, is given immediately. Slower acting starchy food, such as a sandwich or two biscuits and a glass of milk, should be given once the pupil has recovered, some minutes later. If the pupil s recovery takes longer, or in cases of uncertainty, call an ambulance. 114 Greater than usual need to go to the toilet or to drink, tiredness and weight loss may indicate poor diabetic control, and schools will naturally wish to draw any such signs to the parents attention. 116 In the most severe cases of anaphylaxis, people are normally prescribed a device for injecting adrenaline. The device looks like a fountain pen and is pre-loaded with the correct dose of adrenaline and is normally injected into the fleshy part of the thigh. The needle is not revealed and the injection is easy to administer. It is not possible to give too large a dose using this device. In cases of doubt it is better to give the injection than to hold back. Responsibility for giving the injection should be on a purely voluntary basis and should not, in any case, be undertaken without training from an appropriate health professional. 117 For some children, the timing of the injection may be crucial. This needs to be clear in the health care plan and suitable procedures put in place so that swift action can be taken in an emergency. 18
22 The pupil may be old enough to carry his or her own medication but, if not, a suitable safe yet accessible place for storage should be found. The safety of other pupils should also be taken into account. If a pupil is likely to suffer a severe allergic reaction all staff should be aware of the condition and know who is responsible for administering the emergency treatment. 118 Parents will often ask for the school to ensure that their child does not come into contact with the allergen. This is not always feasible, although schools should bear in mind the risk to such pupils at break and lunch times and in cookery, food technology and science classes and seek to minimise the risks whenever possible. It may also be necessary to take precautionary measures on outdoor activities or school trips. Allergic Reactions 119 Symptoms and signs will normally appear within seconds or minutes after exposure to the allergen. These may include: a metallic taste or itching in the mouth 120 Each pupil s symptoms and allergens will vary and will need to be discussed when drawing up the health care plan. 121 Call an ambulance immediately particularly if there is any doubt about the severity of the reaction or if the pupil does not respond to the medication. swelling of the face, throat, tongue and lips difficulty in swallowing flushed complexion abdominal cramps and nausea a rise in heart rate collapse or unconsciousness wheezing or difficulty breathing 19
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